经肋间隙探查定位于内乳区的前哨淋巴结对乳腺癌淋巴分期的影响

目的 探讨乳腺癌前哨淋巴结在内乳区时对其探查与否对淋巴结分期的影响。方法 2006-01—2016-01间,对501例c T1-4N0-1M0期乳腺癌患者进行前哨淋巴结探查术,发现有蓝染淋巴管通向内乳区的患者,经肋间隙入路行内乳区前哨淋巴结活检术(IM-SLNB)+腋窝前哨淋巴结探查+改良根治术100例为A组;行腋窝前哨淋巴结探查+改良根治术401例为B组。观察A组经肋间隙入路IM-SLNB的病理结果与假设该组病例不探查相对比,了解探查对其淋巴分期的影响。观察经肋间隙入路的IMSLNB对手术时间、出血、并发症及恢复等的影响。结果 A组探查发现内乳区淋巴结癌转移19例相对于假设不探查为0例,其淋巴结分期修正率19.0%,(P0.05)有统计学意义;经肋间隙入路IM-SLNB阶段所用时间(23.93±5.89)min;仅1例术中胸廓内动脉出血,切断肋软骨显露血管后结扎止血,出血量约10~20 m L,其余99例均5 m L;胸膜破损0例、气胸0例;术后并发症和愈合时间与B组无统计学差异(P0.05)。结论 选择乳腺癌前哨淋巴结在内乳区时对其进行探查其阳性率高,有助于淋巴结准确分期;经肋间隙入路的内乳区淋巴结探查,创伤小、风险小、不增加并发症。

Influence of internal mammary sentinel Lymph node probe on breast cancer accurate staging

Objective To investigate the mammary sentinel lymph node probe on lymph node staging. Methods Kaifeng City Tumor Hospital from January 2006 - January 2016 diagnosis and treatment of breast cancer stage CT1-4 N0-1M0 501 cases of patients with sentinel lymph node exploratory surgery,the patient was found blue dye within the lymphatic vessels leading to the breast area,via intercostal space ap-proach be internal mammary sentinel lymph node biopsy( IM-SLNB)+ axillary sentinel lymph node probe 100 cases of modified radical mas-tectomy is group A;axillary sentinel lymph node exploration + modified radical mastectomy 401 cases of group B. A group intercostal space ob-served by the pathological findings IM-SLNB group of patients with the assumption that no exploration compared to understand the impact on their exploration lymphatic staging. To observe the intercostal space approach of IM-SLNB operation time,bleeding,complications and recov-ery. Results Group A probe found that breast cancer lymph node metastasis in 19 cases with respect to the assuming no exploration of 0 case of lymph node,the staging correction rate is 19. 0%,(P﹤0. 05)which was statistically significant;intercostal space approach by IM-SLNB stage elapsed time(23. 93 ± 5. 89)min;only one case of intraoperative thoracic artery bleeding,cutting cartilage revealed blood vessels then hemostasis,bleeding about 10-20 mL,the remaining 99 cases were less than 5 mL;pleural damage 0 case,pneumothorax 0 case;postopera-tive complications and healing time was no significant difference( P﹥0. 05)compared with group B. Conclusion Choose probing when breast cancer sentinel lymph node area,the positive rate is high,and is helpful to lymph accurate staging;by rib gap path of explorating mammary lymph nodes,less invasive,low risk,without increasing complications,should be widely applied.